comparative cohort study for detecting the incidence of trisomy 21 in ART and non-ART neonates

One of the most important points concerning the patients who undergo assisted reproductive techniques [ART] for getting pregnant can be the possible neonatal chromosomal abnormalities as a result of these methods. This study was conducted to help answering a part of this question. This is a historical cohort study from April 2006 to April 2007. Data were collected from women admitted in Mehregan Hospital and Esfahan Infertility Center. 225 of 2000 infertile women who had taken ART methods and 225 of 1800 women undergoing no ART treatment were included in our study. All of the cases were aged 35 or more. Data were obtained from patient files from 2 infertility centers of Isfahan, Iran. Chromosomal analysis was successfully performed for all clinically suspicious infants for trisobmy 21. As a result, 4 cases of trisomy 21 in ART group and 7 in non-ART group were found. Two cases from IUI, 1 case of IVF and 1 of ICSI were found to have trisomy 21 in infants. There was no statistically difference in occurring trisomy 21 in our two groups of study and this was also the same for women undergoing IVF and ICSI. ART methods did not increase the rate of Trisomy 21 according to our study although we found less in ART group, it was not statistically significant

Effectiveness of hysteroscopic repair of uterine lesions in reproductive outcome

Background: Small intrauterine lesions such as septum, adhesion, polyp, and submucous myoma may be of greater significance in causing implantation failure, poor reproductive performance and abnormal uterine bleeding. We studied effectiveness of therapeutic intervention through operative hysteroscopy in improvement of pregnancy outcome and cessation of abnormal uterine bleeding [AUB] in women with pregnancy and fertility problems

Materials and Methods: This prospective cohort study was performed between 2003- 2009 on 65 patients with primary or secondary infertility, recurrent abortion and structural uterine lesions reported in sonography or hysterosalpingography. After hysteroscopic metroplasty, myomectomy, adhesiolysis and polypectomy under laparoscopic guide, we evaluated reproductive outcome, early and late complications, one year after surgery

Results: Among all patients with recurrent abortion, 6 patients [75%] complete their pregnancy successfully. Our results showed that pregnancy rate after metroplasty was 58%. Reproductive outcome was poor after myomectomy and adhesiolysis. Abnormal uterine bleeding was improved in 62% of patients

Conclusion: Structural uterine lesions has been assumed to cause infertility, while several studies have shown very poor reproductive performance with high miscarriage and low term delivery rates when malformation is not treated. We show improvement in conceptional outcome and in patient's chief complaints after hysteroscopy surgery of these anomalies

Ovarian ectopic pregnancy: a rare case

Ovarian pregnancy is a rare form of the non-tubal ectopic pregnancy. It ends with rupture before the end of the first trimester. One of the important risk factors for ovarian pregnancy is in the use of Intra uterine devices [IUD]. We report here one such uncommon case of ovarian ectopic pregnancy. Our patient is a 30 years old multiparous woman with two previous cesarean sections with severe hypogastric abdominal pain. During laparotomy, ruptured ovarian ectopic pregnancy was diagnosed, and wedge resection of the ovary was only done. Histopathological examination confirmed it to be an ovarian ectopic pregnancy. IUD is one of contraceptive methods which prevents intra-uterine implantation in 99.5%, if implant occurs with IUD, it is tubal implantation in 95% of cases, and it is very rare in other places such as ovary. The most important risk factor of ovarian ectopic pregnancy is IUD as in this study it was showed

Assessment of the diagnostic capability of serum creatine phosphokinase and its isoenzyme in ectopic pregnancy

Our goal was to assess the diagnostic value of creatine phosphokinase [CPK] and its isoenzyme CPK- muscle brain [MB] in ectopic pregnancy [EP] in order to locate a simpler diagnostic approach for EP. This was a prospective study that performed consecutive sampling for 20 months in two major hospitals in Isfahan, Iran. All pregnant patients in their first trimester of gestation that presented with complaints of vaginal bleeding, abdominal pain, or both enrolled in this study. Blood sampling was performed for laboratory analyses [CPK, CPK-MB]. After their diagnosis was established, patients were put in either the EP or non-EP group. We used SPSS software version 10 for data analysis, diagnostic parameters were determined, and a relative operating characteristic [ROC] curve was plotted for each biochemical marker. A total of 106 patients, 53 in the EP group and 53 in the non-EP group enrolled in this study. The results for CPK were as follows: sensitivity [69.81%], specificity [64.15%], positive predictive value [PPV; 66.07%], negative predictive value [NPV; 68%], positive likelihood ratio [PLR] [1.95], and negative likelihood ratio [NLR] [0.49]. The results for CPK-MB were: sensitivity [71.7%], specificity [56.6%], PPV [62.29%], NPV [66.7%], PLR [1.65], and NLR [0.5]. The area under the ROC curve for CPK was 0.692 and for CPK-MB it was 0.647. Although we have observed a significant elevation in CPK and CPK-MB serum levels in EP, transvaginal ultrasound [TVS] is still the better diagnostic tool for EP.

Comparison study on effectiveness of pentoxifyllin with LD to prevent recurrent endometriosis

About 75% of the symptomatic patients who involved with endometriosis have pelvic pain and dysmenorrhea. Pentoxifyllin is one of the drugs that according to its mechanism could be effective for pain relief of endometriosis which has been used for endometriosis treatment recently. We conducted a comparative study for detecting the effect of pentoxifylin [as an immonomodelator] in preventing recurrence endometriotic pain with pentoxifylin plus a combined contraceptive pill with low dose estrogen [LD] and also the LD pill alone. This was a comparative clinical trial on 83 patients with the chief complaint [CC] of pain [dysmenorrheal /or pelvic pain] and with the end diagnosis of endometriosis, in an operative laparoscopy. Patients, dividing to 3 groups, were treated with pentoxifylin, pentoxifylin+LD and LD alone for 10 months. The severity of pain [dismenorhea and/or pelvic pain] was detected by visual analogue scale [VAS] before and after the treatment. The severity of endometriosis in the patients was: I in class I and II in class II and III in class III. The groups were matched for the pain. The number of the patients in group 1, 2 and 3 were 28, 28 and 27 respectively. The pain was reduced in the groups of pentoxifylin+LD [p<0.001] and LD alone [p=0.00]. The pain relief was not significant in the group of pentoxifylin alone [p=0.136]. After treatment, the severity of pain was not significantly different between the LD group and the LD+penthoxyfillin group, but there was difference between these two groups and the group of penthoxyfillin alone. This study showed that penthoxyfillin actually could not have any effect on the pain relief of endometriosis. It also made it clear that penthoxyfillin could not increase the efficacy of LD when used with this medication

[ evaluation of frequency of hypotention in normal vaginal delivery with epidural anesthesia in Beheshti and Jorjani hospitals of Isfahan 2003]

Delivery pain is one of the most severe known pains that can be considered a critical experience in lifelong for every woman .Different methods has been introduced for reducing delivery pain such as non pharmacological methods [hypnotism, Acupuncture] and pharmacological methods [systemic drugs, inhalant anesthetics regional anesthesia]. Now, the most popular methods for pain relief in labor is regional anesthesia. The most common techniques are spinal, epidural, para cervical and pudendal anesthesia. The most effective ways for pain relief in labor is spinal and epidural block that Produces a complete pain relief in most women. The purpose of this study is determining the distribution of hypotention as a most common complication of epidural anesthesia in vaginal delivery that can lead to fetal distress and low APGAR score and cesarean section. This is a cross sectional [descriptive-analytic] study and 137 cases were studied. Most of them were 21-30 years old. This study was approved by the local committee of medical ethics. Gestational age was 37-42 weeks .This study was established in fall and winter of year 2003 at Beheshti and Jorjani hospitals. All of them were at the same conditions and all epidural blocks were done with the same anesthesiologist. The data analysis of all cases showed that the distribution of hypotention was 16.1%. Distribution of vertigo was 20.4% .The neonatal APGAR score of those mothers who had hypotention during delivery was [8 +/- 1.23] while APGAR score of those ones who didn't have hypotention was 9 or more [P<0.001]. Hypotension is a common side effect of epidural anesthesia and it can cause fetal distress and low APGAR score, but with infusion 500-1000 CC ringer lactate boxter before anesthesia, can reduce rate of hypotension, prevent hypoxia side effects and low score of APGAR. Of curse 1 degree reduction in APGAR score may be resulted from length of stage II of labor. So epidural anesthesia can be considered as a reliable and safe method for advertising vaginal delivery and reducing the number of unnecessary cesarean section